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A Purposeful Approach to Articulate and Enhance Nursing Influence Across Policy, Research, Education, Practice, Theory, Media, and Industry

Adams, Jeffrey M. PhD, RN, NEA-BC, FAAN; Glassman, Kimberly PhD, RN, NEA-BC, FAAN; McCausland, Maureen DNSc, RN, FAAN; Pappas, Sharon PhD, RN, NEA-BC, FAAN; Manges, Kirstin PhD, RN

JONA: The Journal of Nursing Administration: September 2019 - Volume 49 - Issue 9 - p 397–399
doi: 10.1097/NNA.0000000000000774
Departments: Guest Editorial
Free
SDC

Author Affiliation: Principal Emeritus (Dr Adams), Jeff Adams, LLC, Belmont, Massachusetts; Senior Vice President of Patient Care Services and Chief Nursing Officer at NYU Langone Health (Dr Glassman), New York; Senior Advisor (Dr McCausland), McChrystal Group, Alexandria, Virginia; Chief Nurse Executive (Dr Pappas), Emory Healthcare, Atlanta, Georgia; National Clinician Scholar (Dr Manges), University of Pennsylvania, Philadelphia.

The authors declare no conflicts of interest.

Correspondence: Dr Adams, 56 Oxford Ave, Suite 1, Belmont, MA 02478 (jeff@jeffadamsllc.com).

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.jonajournal.com).

Online date: August 14, 2019

Influence is the ability of an individual to sway or persuade another person or group based on authority, communication traits, knowledge based competence, status, and time and timing. Power, in contrast, can be identified as being influential about many issues.1-3

For over 160 years, formally trained nurses have been counted on to provide care to keep healthy people healthy, addressing needs of sick people in efforts to make them well, and with the maintenance of conditions to minimize progression of illness. As there is an increasing need for innovative models to address access, cost, quality of care, and workforce4,5 wellness to better the culture of health, nurses are potentially best educated and positioned to identify, define, and lead these new models.6

Nurses are by far the largest professional group numbering more than all nutritionists, physicians, social workers, occupational therapists, physical therapists, and pharmacists combined.7 Nurses are annually identified as the most trusted professional group8 and highly regarded and generally outwardly supported by the public, clinical colleagues, and the media. This is heightened especially whenever someone speaks negatively about nursing, such as a state senator suggesting that nurses spend a good deal of their work time playing cards at work,9 a talk show host questioning why a nurse would wear a “doctor's stethoscope,”10 or syndicated cartoonists suggesting that nurse practitioners are a lesser type of provider.11

Thus, it is both an interesting and concerning paradox as the most trusted profession, representing the overwhelming percentage of the healthcare workforce, regularly supported/defended when represented negatively in media forums and likely best positioned to advance new healthcare models, self-reports as being less influential than their interprofessional healthcare executive counterparts,12,13 is identified by others as having limited influence in health policy14 and is not consistently consulted in health system executive decisions.15

The origins of nursing's limited influence have been well chronicled, stemming in part from the origins of the profession as selfless helpers or as a means to add income to a family, a history of multiple educational paths, gender inequalities, state- or organizational-specific practice regulations, limited access to resources, and media depiction of nurses, in addition to internal challenges, such as increasing turnover.16-18 Nurses contributions are often completed while leading quietly from the back. This, however, likely has a limiting and possibly a detrimental effect on the health of our population. There is a need for nurses not only to be at tables, but also to accurately represent insights, experiences, and unique contributions to influence a more efficient utilization of the healthcare workforce to improve the health of everyone.

To purposefully identify a strategy to move nursing from the most trusted to most influential across Policy, Research Education, Practice, Theory, Media, and Industry (PREP-TMI), the American Academy of Nursing's Building Healthcare Systems Excellence expert panel, which comprised many of the most senior leadership in nursing organizations, healthcare systems, and academic institutions, held an invitational meeting in February 2019 in New York (Supplemental Digital Content 1, http://links.lww.com/JONA/A706).

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Our Call to Action

Initial outcomes from this meeting framed the advancement of nursing influence for the betterment of health as a collective impact Grand Challenge.19 A collective impact Grand Challenge is a large transformative societal goal that aligns many individuals and organizations to achieve an outcome. Examples of Grand Challenges are movements to encourage car seat use and lessen tobacco use and the recent American Nurses Association–sponsored Healthy Nurse, Healthy Nation.20 A Grand Challenge does not dictate a specific course, but rather asks each contributor to provide his/her unique perspective and expertise.

There are a number of groups working collaboratively to enhance the influence of nurses in PREP-TMI. However, in the context of the Grand Challenge, the aim is to formally and explicitly engage the broader world in this long-term call to action. When discussing the importance of advancing nursing influence, Maureen McCausland, Senior Advisor, McChrystal Group, Alexandria, VA, said “In the world of disruption, there will be healthy people who want to maintain their health and prevent disease. There will be sick people where nurses partner with patients to reduce the impact of disease or injury that has already occurred. There will be patients who partner with nurses to try and improve quality of life and reduce the symptoms of a disease. People are interested in primary prevention. Nurses really have the science and skill set to design and help new models of care make an impact at all levels of prevention in ways people want and sometimes actually expect” (M.M., personal communication, February 11, 2019).

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How Can I Help?

There is not a prescription to solve this image and impact issue; the most important thing is to believe, contribute, and share. Some initial thoughts and efforts might include the following:

  • Educate yourself on the concept of Influence1-3 and a collective impact Grand Challenge approach.19,20
  • Be clear in how your project, publications, and research results advance the profession of nursing and inform others through dissemination.
  • Share publications across social media in lay language to inform and engage the public on the contributions that are designed by nurses.
  • Share your work and influence efforts in publications and venues that reach the general population and other professions.
  • Consider negative portrayals of nurses (such as those mentioned above) as opportunities for purposeful teachable moments. If nursing is misunderstood, it is nurses' responsibility to educate the population and not vilify someone's limited understanding.
  • If you are (or know of) a student working on a project, consider purposefully including as an outcome articulating how efforts contribute to the influence Grand Challenge across PREP-TMI.
  • Use the phrase “nurses and physicians” and do not use “doctors and nurses” and help others understand this as purposeful. Many nurses have doctoral degrees and thus have earned the right to be referred to as “doctor.”
  • Check in and participate with the professional organization of your choice around enhancing nursing's influence across PREP-TMI.
  • Empower yourself to use opportunities to use your voice as a nurse in your practice settings and your communities.
  • Participate in an active conversation with panel members on LinkedIn. Access the site at: https://www.linkedin.com/pulse/purposeful-approach-articulate-enhance-nursing-influence-jona-.
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Acknowledgments

The authors would like to thank Kathy Coichette-Mazzeo, NYU Langone and Rachael James, American Academy of Nursing for their assistance in organization and coordination of this meeting.

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References

1. Adams JM. The Adams Influence Model (AIM): Understanding the Factors Attributes and Process of Achieving Influence. Saarbrüken, Germany: VDM Verlag; 2009.
2. Adams JM, Natarajan S. Understanding nursing influence: development of the Adams Influence Model using practice, research, and theory. Adv Nurs Sci. 2016;39(3).
3. Adams JM, Bryant Chapman D, Manges K. Advancing the influence. In: Adams JM, Mensik J, Reid Ponte P, Somerville J, eds. Lead Like a Nurse: Leadership in Every Healthcare Setting. ANA Press; 2018.
4. Bodenheimer T, Sinsky C. From Triple to Quadruple Aim: care of the patient requires care of the provider. Ann Fam Med. 2014;12(6):573–576.
5. Sikka R, Morath JM, Leape L. The Quadruple Aim: care health, cost and meaning in work. BMJ Qual Saf. 2015;24:608–610.
6. Adams JM, Zimmermann D, Cipriano PF, Pappas S, Batcheller J. Improving the work life of health care workers: building on nursing's experience. Med Care. 2018;56(1):1–3.
7. Bureau of Labor Statistics. Healthcare practitioners and technical occupations. https://www.bls.gov/oes/current/oes_stru.htm#29-0000. Accessed August 8, 2019.
8. Brenan M. (2018). Nurses again outpace other professions for honesty, ethics. Robert Wood Johnson Foundation and Gallup. https://news.gallup.com/poll/245597/nurses-again-outpace-professions-honesty-ethics.aspx. Accessed June 1, 2019.
9. Walsh M. State Senate Floor Debate SHB 115 Healthcare Employees. Olympia, WA: YVW TV; April 16, 2019.
10. Behar J. Opening Monologue/Discussion. New York, NY: ABC TV; September 8, 2015.
11. Teitelbaum E, Teitelbaum B. Bottom Liners [Cartoon]. Tribune Content, LLC; March 26, 2019.
12. Adams JM, Duffy ME, Clifford JC. Knowledge and Influence of the Nurse Leader: A Survey of Participants From the 2005 Conference. Boston, MA: Institute for Nursing Healthcare Leadership; 2006.
13. Adams JM, Ives Erickson J, Duffy ME, Jones DA, Aspell Adams A, Clifford JC. Knowledge and Influence of the Nurse Leader: A Survey of Participants From 2006. Boston, MA: Institute for Nursing Healthcare Leadership; 2007:2006.
14. Robert Wood Johnson Foundation and Gallup. (2010). Nursing leadership from bedside to boardroom: opinion leaders' perceptions. http://www.rwjf.org/en/library/research/2010/01/nursing-leadership-from-bedside-to-boardroom.html. Accessed July 22, 2019.
15. Health Research & Educational Trust. Building a Leadership Team for the Health Care Organization of the Future. Chicago, IL: Health Research & Educational Trust; 2014.
16. Reverby S. Ordered to Care: The Dilemma of American Nursing. Cambridge: Cambridge University Press; 1987:1850–1945.
17. Godden J. Victorian influences on the development of nursing. In: Gray G, Pratt R, eds. Scholarship in the Discipline of Nursing. Melbourne, Australia: Churchill Livingstone; 1995:243–258.
18. Sullivan EJ. Becoming Influential: A Guide for Nurses. Upper Saddle River, NJ: Pearson Educational Inc; 2004.
19. Hanleybrown F, Kania J, Kramer M. Channeling change: making collective impact work. Stanford Soc Innov Rev. 2012:1–8.
20. American Nurses Association Enterprise. Healthy Nurse Healthy Nation, what is a Grand Challenge. 2019. http://www.healthynursehealthynation.org/en/about/what-is-a-grand-challenge. Accessed June 1, 2019.

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